Hypoxic ischemic encelopathy

Question 1

What is HIE?

Answer 1

Its the consequence of perinatal (just before, during or just after birth) asphyxia
Many causes -
commonly leads to cerebral palsy (but can also lead to death/worse)

Question 2

Causes of HIE?

Answer 2

Anything that restricts Oxygen to foetus, or causes non-breathing at birth

failure of gas exchange at placenta (placental abrution-seperation of uterus and placenta)
cord blood interuption (eg: Shoulder dystocia (shoulder stuck in mum during birth)
Inadequate perfusion (maternal hypotension, heammorhage)
Compromised featus (IGUR)
Failure to breath at birth (premmies)

Question 3

Signs and Sx of HIE

Answer 3

3 categories -mild -moderate-severe
determined by their reaction up to 48h after birth

Mild - irritable, excessive response to stimuli, high RR, staring eyes, HYPERTONIC ->should resolve fine
Moderate -abnormal movement, HYPOTONIC, not feeding, Seizures
-if resolve in 2 weeks- good. if not, bad prognosis

Severe -No movements or reaction, Hyper and Hypotonic, long/repeating seizures, organ failure
-> bad mortality, bad prognosis (cerebral pasly very common)

Question 4

Management of HIE

Answer 4

Supportive -
Resp support
Anticonvuslants
Fluid restric for renal impairment
Ionotropes for hypotense
Electrolytes/glucose

For severe - hypothermia under 36C in NICU -reduce morbidity